Component Task: Management of Severe Pre-Eclampsia

This is an emergency obstetric care given by the midwife to a pregnant woman/client with a systolic blood pressure of 160mmHg and diastolic pressure of at least 110mmHg with proteinuria. There may be other related symptoms such as blurred vision, epigastric pain and persistent frontal headache.

Aims

·         Prevent client from having eclampsia

·         Prevent foetal compromise and death

·         Prevent other maternal morbidities

·         Expedite delivery of foetus

·         Prevent complications

Requirements

a.      Vital signs tray

b.      Delivery tray

c.      Induction tray

d.      Oxytocin

e.      Anticonvulsant e.g. Magnesium Sulphate

f.        Intravenous line tray

g.      IV Fluids e. g. Normal Saline or Ringer’s Lactate

h.      Urethral Catheter and Urine Bag

i.         Foetal monitor (manual /electronic)

j.         Intake and Output chart

k.       Oxygen Apparatus

l.         Suction Apparatus

m.   Perineal Pad

n.      Theatre Gown and Cap

o.      Consent Form

p.      Patella Hammer

q.      Urine Dipsticks

r.        Blood and Urine sample bottles

s.       Maternal and Child Health Record Book (Manual/Electronic)

Steps

1.        Establish rapport (refer steps)

2.      Explain procedure to client (refer steps)

3.      Explain to client the need to attend antenatal clinic and procedures involved

4.      Perform a rapid evaluation of the general condition of the woman, including vital signs

5.      Take history of the present and past illness from her relatives

6.      Ascertain gestational age to help in proper diagnosing of pre-eclampsia

7.       Maintain Infection Prevention and Control measures throughout management

8.      Perform general examination from head to toe

9.      Obtain urine sample and test for protein and sugar

10.    Take blood sample for BUE & Creatinine, FBC, Rh status, grouping and cross matching etc.

11.      Monitor vital signs, reflexes, foetal heart rate every hourly and record

12.    Gather equipment for convulsion management (airway, suction, mask and bag, nasal prongs, oxygen)

13.    Start anticonvulsant as per WHO/GHS protocols

14.    Pass indwelling urethral catheter to monitor urine output (at least 30 ml per hour) and proteinuria

15.    Discontinue anticonvulsive therapy if urine is less and infuse normal saline or Ringer’s Lactate solution at maintenance rate (100-125 ml/hour) but monitor for the development for pulmonary oedema

16.    Ensure safety of client by pulling up side rails (Never leave the woman alone because convulsion may follow soon)